Women's unequal position in sexual negotiations highlights the need for methods, such as the female condom, that they can initiate. In South Africa, the female condom has been endorsed as a pregnancy and disease prevention method, and, since the launch of a government-sponsored introductory strategy, demand has been growing. The female condom has the potential to enhance women's bargaining power within their relationships, but its successful use also depends on male partner cooperation. Few interventions for women to learn female condom negotiation skills have been developed and evaluated, especially in settings such as South Africa, where unequal gender relations pose a special challenge. The proposed study will develop and test a two-session, culture-specific, group-based female condom negotiation and insertion skills intervention on a South African university campus. Specific study aims areto (1) develop, implement, and test the effectiveness in a randomized controlled trial of a brief cognitive-behavioral intervention versus a standard information-only intervention on short- and long-term use of the female condom, total number of male and female condom-unprotected occasions, and female condom attitudes among South African female university students; (2) identify the individual, contextual, and method-related determinants of female condom initiation, maintenance, and discontinuation; (3) explore the context of the introduction and use of the female condom for both women and their male partners using qualitative methods, and (4) explore men's attitudes about the female condom and men's role in female condom use. In the Preparatory Research Phase, formative qualitative work (ethnographic mapping on campus and 20 focus groups, N = 200) and a campus-wide representative cross-sectional survey of 1,000 students will be conducted to understand the social context and characterize the target population, formulate appropriate intervention messages, and serve as a recruitment source for the Phase II trial. The Trial Phase will test the effectiveness of a cognitive-behavioral skills intervention against an information-only control condition on short- and long-term use and discontinuation of the female condom among 280 women. Participants will be assessed prior to and immediately post-intervention, and at three and six months thereafter. In-depth interviews with 70 female trial participants and 70 of their male partners will augment data provided by women participants to increase understanding of the contextual factors that influence initial adoption, long-term use and discontinuation of the female condom. If successful, this brief intervention should be widely replicable in other similar settings.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD046351-04
Application #
7271840
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Newcomer, Susan
Project Start
2004-09-06
Project End
2009-07-31
Budget Start
2007-08-01
Budget End
2008-07-31
Support Year
4
Fiscal Year
2007
Total Cost
$507,061
Indirect Cost
Name
New York State Psychiatric Institute
Department
Type
DUNS #
167204994
City
New York
State
NY
Country
United States
Zip Code
10032
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Schuyler, A C; Masvawure, T B; Smit, J A et al. (2016) Building young women's knowledge and skills in female condom use: lessons learned from a South African intervention. Health Educ Res 31:260-72
Mantell, Joanne E; Smit, Jennifer A; Exner, Theresa M et al. (2015) Promoting Female Condom Use Among Female University Students in KwaZulu-Natal, South Africa: Results of a Randomized Behavioral Trial. AIDS Behav 19:1129-40
Masvawure, Tsitsi B; Mantell, Joanne E; Mabude, Zonke et al. (2014) ""It's a different condom, let's see how it works"": young men's reactions to and experiences of female condom use during an intervention trial in South Africa. J Sex Res 51:841-51
Mantell, Joanne E; Smit, Jennifer A; Beksinska, Mags et al. (2011) Everywhere you go, everyone is saying condom, condom. But are they being used consistently? Reflections of South African male students about male and female condom use. Health Educ Res 26:859-71
Mantell, Joanne E; Needham, Sarah L; Smit, Jennifer Ann et al. (2009) Gender norms in South Africa: implications for HIV and pregnancy prevention among African and Indian women students at a South African tertiary institution. Cult Health Sex 11:139-57
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Mantell, Joanne E; Dworkin, Shari L; Exner, Theresa M et al. (2006) The promises and limitations of female-initiated methods of HIV/STI protection. Soc Sci Med 63:1998-2009